Drug and Alcohol Misuse - What Are The Treatment Options?

The following article aims to give a brief introduction into the main treatment options available to drug users in the UK.

It is not an exhaustive list and many minor and alternative treatments may be used by individuals to varying degrees of success.

Advice and Information

Advice and information is provided by non-specialists such as GP's, A&E departments and for young people schools and youth clubs. It covers topics such as

• Advice and Information on drugs and alcohol, and their effects
• Advice on reduction in drug use and stopping altogether.
• Some harm reduction information if appropriate.
• Local services and how to access
• Other local providers, housing, employment etc.
• Advice and information for significant others, parents, carers, partners etc.

Harm Reduction

Harm reduction services are mainly focused on preventing diseases passed on by contaminated blood (particularly HIV and hepatitis infections), preventing overdose and drug-related death. All drug treatment services should have this as a core element of their service. Harm reduction examples include: 

• needle exchange services,
• Safer injecting advice and support services.
• advice and information on preventing infections associated with drug misuse, particularly hepatitis A, B and C, and HIV (blood-borne viruses)
• testing, advice, information and counselling around hepatitis and HIV
• Hepatitis A and B vaccinations
• Treatment for hepatitis B, C and HIV infection
• Overdose prevention services and reducing drug-related death
• Client assessment and onward referral where appropriate

Community Prescribing

Community prescribing is specialised drug treatment in the context of a care plan. Provided as part of primary care, by a GP specialising in drug misuse or a doctor in drug treatment service. Where clients receive the treatment may depend on the seriousness of their problems, duration in treatment or stability. Prescribing can include: 

• Client stabilisation on substitute medication
• Prescription of substitute medication, such as methadone and buprenorphine, for a sustained period (maintenance prescribing)
• prescribing for withdrawal (community detoxification)
• prescribing for relapse prevention
• stabilisation and withdrawal from sedatives, such as Valium and Temazepam
• prescribing for assisted withdrawal from alcohol, where appropriate
• treatment for stimulant users, which can be prescribing to help relieve symptoms
• non-medical prescribing (by nurses or pharmacists)

Counselling and psychological support

Counselling and psychological support should not be confused with advice and information. Counselling and psychological support should always be carried out by trained and competent professionals and be included in a client's care plan. It needs to be formal, structured, clearly defined on treatment plans and client cantered. Psychological therapies can include cognitive behaviour therapy (CBT), MI (motivational interviewing), coping skills, solution focused therapy, relapse prevention therapy and family therapies.

Structured Day Programmes

Structured day programmes run a set of activities for a fixed period of time (e.g. 12 weeks). Clients attend these services according to a set attendance level (usually 3-5 days a week), as set out in their care plans. There is a timetable of activities which will either be the same for everyone, or be set individually for clients according to their needs. Programmes often include group work, counselling, education and life skills, and creative activities and training.

Detox

Medically known as "assisted withdrawal" detox involves a stay as an inpatient. Most people using detox services are given medication to help clear their bodies of drugs. The inpatient treatment may also include stabilisation on substitute medication, emergency medical care for drug users in crisis, and possibly treatment for stimulant users. As well as inpatient treatment, other services may be offered, such as preparation for entering treatment, counselling and psychological support, help with alcohol problems, harm reduction and treatment for BBV. Inpatient treatment is provided in: 

• hospital wards (usually psychiatric wards)
• drug inpatient units
• residential rehab units with attached detox units

Clients usually enter inpatient treatment through referral from community drug services. It is important that adequate support is made available to people leaving inpatient treatment as this can reduce the risk of relapse.

Residential Rehabilitation (Rehab)

Residential rehabilitation or rehab involves clients staying in a residential unit for weeks maybe months and a complete separation from their current social situation. Residential units normally offer a mixture of group work, counselling and practical and vocational activities. There are several types of residential rehabilitation providers: 

• traditional rehab units,
• crisis intervention units - these usually offer a shorter stay
• residential treatment programmes for particular client groups
• Supported accommodation, where some clients go to after rehab

As with inpatient treatment, clients will generally to referred by community drug services. People coming into rehab services will usually have often gone through detoxification before entering. The detox could have been somewhere else - a hospital, or in the community for example - or at the rehab itself, if it has an attached detox unit.

Aftercare

Aftercare is the support offered when clients leave structured treatment. The aim is to maintain the positive changes that clients have made in their treatment, and support them to return to normal life. Examples include support for housing, education, employment, general health care and relapse prevention.

Mark Bowles

www.thetrainingeffect.co.uk